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One in Every 20 Adults Is Misdiagnosed in Outpatient Clinics Every Year

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One in Every 20 Adults Is Misdiagnosed in Outpatient Clinics Every Year

Written by Sandra Levy
| Published on April 17, 2014

A new study finds that many Americans are misdiagnosed in outpatient clinics, but researchers believe that if patients and physicians work together, the high rates of misdiagnosis will decline.

A new study, published in BMJ Quality and Safety, finds that one in every 20 adults in the U.S.—which translates to
about 12 million adults—is misdiagnosed in outpatient clinics every
year. What's more, many of these misdiagnoses have the potential to cause serious harm.

According
to the Society to Improve Diagnosis in Medicine, diagnostic error is
the leading cause of medical malpractice claims in the U.S., and is
estimated to cause 40,000 to 80,000 deaths annually.

The
data sources in the new study included two previous studies that used
electronic triggers, or algorithms, to detect unusual patterns of return
visits after an initial primary care visit, or lack of follow-up after
abnormal clinical findings related to colorectal cancer—both suggestive
of diagnostic errors. A third study examined consecutive cases of lung
cancer.

In all three studies, diagnostic errors were confirmed
through chart review and defined as missed opportunities to make a
timely or correct diagnosis based on available evidence.

In a
previous study, the researchers looked at the likelihood of these misdiagnoses inconveniencing patients or leading to severe
disability, and found that almost half of the misdiagnoses would be
harmful to the patient.

Factors Contributing to Misdiagnosis Rates

Lead study
author Dr. Hardeep Singh, patient safety researcher at the Veterans
Affairs Center for Innovations in Quality, Effectiveness and Safety, at
the Michael E. DeBakey VA Medical Center in Houston and an
associate professor at Baylor College of Medicine, told Healthline that there are several reasons why misdiagnosis rates are high. “For
physicians, there are several issues, such as how they make decisions
and how they handle uncertainty. When a patient comes in with a lot of
undifferentiated symptoms, in primary care the diagnosis evolves over
time and you might start with a certain work-up, but that changes,” said Singh.

Singh
went on to say that physicians should make patients more aware of how
things will evolve and what patients need to do. “Some of the follow-up
issues are important too. When people have abnormal findings, we need to
ask, how do we track them better over time? If they had an abnormal
test, patients need to ask, How do I get informed? When is my next
test scheduled?” said Singh.

Which
diseases represent the highest number of misdiagnoses? In addition to
cancer, Singh said that common symptoms are often missed in common diseases,
such as decompensated heart failure in patients, pneumonia, anemia,
spinal cord compression, and kidney failure.

Patients and Doctors Need to Partner

What
can a patient do to prevent a misdiagnosis? Singh advised patients to
be proactive by providing physicians with a list of their symptoms and
their medical problems. Patients should also have access to all the information.

“We are
going to need to have more engagement and empowerment in patients in
order to take this issue forward. We cannot do this without having more
patient participation in this process. If I express uncertainty that
your diagnosis is bronchitis, and you may also have heart failure, then if
you get swelling in the legs or your breathing gets worse, I want you to
come back and see me tomorrow or the day after. We want doctors to
express uncertainty, but we also want patients to come back and see us,”
said Singh.

A Multifaceted Approach Is Also Needed

Finally,
Singh told Healthline, “This has to be a multi-faceted effort involving
physicians, their care teams, patients, and the healthcare system where
we practice. Everybody plays a role. Not all misdiagnoses are going to
lead to problems. You do get problems when there’s a delay in needed
treatment and when you get unnecessary tests, but it’s obviously not good to
get misdiagnosed for any reason.”

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